Determinants of procedural pain intensity in the intensive care unit: the Europain® study
Journal
American Journal of Respiratory and Critical Care Medicine
Date Issued
January 1, 2014
Author(s)
DOI
10.1164/rccm.201306-1174OC
Abstract
Rationale:Intensive care unit (ICU) patients undergo several diagnostic
and therapeutic procedures every day. The prevalence, intensity, and risk
factors of pain related to these procedures are not well known.
Objectives: To assess self-reported procedural pain intensity versus
baseline pain, examine pain intensity differences across procedures,
and identify risk factors for procedural pain intensity.
Methods: Prospective, cross-sectional, multicenter, multinational
study of pain intensity associated with 12 procedures. Data were
obtained from 3,851 patients who underwent 4,812 procedures in 192
ICUs in 28 countries.
Measurements andMain Results: Painintensity on a 0–10 numeric
rating scale increased significantly from baseline pain during all
procedures (P , 0.001). Chest tube removal, wound drain removal, and
arterial line insertion were the three most painful procedures, with
median pain scores of 5 (3–7), 4.5 (2–7), and 4 (2–6), respectively. By
multivariate analysis, risk factors independently associated with greater
procedural pain intensity were the specific procedure; opioid
administration specifically for the procedure; preprocedural pain
intensity; preprocedural pain distress; intensity of the worst pain on the
same day, before the procedure; and procedure not performed by a nurse.
A significant ICU effect was observed, with no visible effect of country
because of its absorption by the ICU effect. Some of the risk factors
became nonsignificant when each procedure was examined separately. Conclusions: Knowledge of risk factors for greater procedural pain
intensity identified in this study may help clinicians select
interventions that are needed to minimize procedural pain.
Clinical trial registered with www.clinicaltrials.gov (NCT 01070082).
and therapeutic procedures every day. The prevalence, intensity, and risk
factors of pain related to these procedures are not well known.
Objectives: To assess self-reported procedural pain intensity versus
baseline pain, examine pain intensity differences across procedures,
and identify risk factors for procedural pain intensity.
Methods: Prospective, cross-sectional, multicenter, multinational
study of pain intensity associated with 12 procedures. Data were
obtained from 3,851 patients who underwent 4,812 procedures in 192
ICUs in 28 countries.
Measurements andMain Results: Painintensity on a 0–10 numeric
rating scale increased significantly from baseline pain during all
procedures (P , 0.001). Chest tube removal, wound drain removal, and
arterial line insertion were the three most painful procedures, with
median pain scores of 5 (3–7), 4.5 (2–7), and 4 (2–6), respectively. By
multivariate analysis, risk factors independently associated with greater
procedural pain intensity were the specific procedure; opioid
administration specifically for the procedure; preprocedural pain
intensity; preprocedural pain distress; intensity of the worst pain on the
same day, before the procedure; and procedure not performed by a nurse.
A significant ICU effect was observed, with no visible effect of country
because of its absorption by the ICU effect. Some of the risk factors
became nonsignificant when each procedure was examined separately. Conclusions: Knowledge of risk factors for greater procedural pain
intensity identified in this study may help clinicians select
interventions that are needed to minimize procedural pain.
Clinical trial registered with www.clinicaltrials.gov (NCT 01070082).